Abstract 18647: Comparison of Handheld and Standard Transthoracic Echocardiography in Patients with Acute Myocardial Infarction
Introduction: Handheld echocardiography (HHE) is concordant with standard transthoracic echocardiography (TTE) in a variety of clinical settings. Given its bedside availability, using HHE in patients with acute myocardial infarction carries clinical appeal. However, HHE has not been thoroughly compared to traditional TTE in these patients. This study sought to define the diagnostic capability of HHE in patients with acute myocardial infarction.
Methods: This study prospectively enrolled patients admitted to the coronary care unit with acute ST or non-ST segment elevation myocardial infarction. Experienced sonographers performed HHE with a V-scan (GE Healthcare, Waukesha, WI). All patients underwent standard TTE as a part of their clinical care. HHE was interpreted by two expert echocardiographers blinded to TTE results. Agreement between HHE and standard TTE was assessed with kappa statistics for categorical variables and correlation coefficients for continuous variables.
Results: Analysis included 82 patients (mean age 66; 74% male). HHE was performed 5.9±16 hours before standard TTE. HHE required 9.9±2.2 minutes to complete and included 41±9 clips. On TTE, mean left ventricular ejection fraction (LVEF) was 46%, and median wall motion score index (WMSI) was 1.625. Correlation coefficients were 0.84 (CI 0.77-0.90) for LVEF and 0.73 (CI 0.61-0.82) for WMSI. LVEF was ≤40% on TTE in 29 patients (35%); HHE was concordant in 24 of those patients (83%). Kappa statistics were 0.32 for LV enlargement, 0.15 for right ventricular dysfunction, 0.66 for mitral regurgitation (MR) severity, and 0.52 for inferior vena cava (IVC) dilatation. Among the 16 standard LV segments, kappa statistics were highest for the anterior (0.74) and septal (0.64) apex and lowest for the mid inferolateral (0.24) and basal inferoseptal (0.26) walls.
Conclusions: In patients with acute myocardial infarction, HHE and TTE demonstrated good correlation for LV function and wall motion analysis and moderate correlation for MR, left ventricular size, and IVC dilatation. While HHE can provide a quick and satisfactory bedside evaluation of left ventricular function and wall motion, it may not substitute for comprehensive TTE in patients with acute myocardial infarction.
Author Disclosures: M.W. Cullen: None. J.B. Geske: None. N.S. Anavekar: None. J.W. Askew: None. J.K. Oh: None.
- © 2014 by American Heart Association, Inc.